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          <h1 class="post-title" itemprop="name headline">018.2019新锐读会 课程笔记《粘接牙科学的基本原理》01</h1>
        

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        <p>新的课程了，讲粘接的。<br>学习粘接挑战在于，如何检索到最新的信息，如何比较不同的技术和方法。<br>第一阶段：粘接学概述<br>A.粘接的定义<br>定义：用一个界面将两个不同或相同的组分连接到一起。<br>B.粘接的形成<br>粘接的形成源于粘接力——被粘接界面之间界面上的连续作用力或粘合力。<br>1.机械嵌合力<br>2.分子间作用力（范德华力）<br>3.形成化学键<br>C.粘接的专业术语<br>1.亲水性<br>指一滴液体在物体表面的延伸程度，用接触角来衡量。角度较小，亲水性高。<br>2.疏水性<br>接触角大，我们希望粘接以后的界面呈疏水性（家装防水层的重要性）<br>第二阶段：粘接牙科学概述<br>A.粘接牙科学的定义<br>将各种材质的修复体通过粘接材料固定到牙齿表面结构上或其它修复体上以达到修复或治疗效果的技术。<br>B.粘接牙科学的构成因素<br>1.不同程度受损的牙体或修复体<br>2.粘接系统<br>3.修复材料<br>C.粘接牙科学成功要素<br>1.医生本身的技术<br>2.患者的自身情况<br>3.牙科设备及材料的质量<br>4.临床方案的选择<br>D.粘接牙科学失败的因素<br>1.修复体的损坏（短时间内）<br>修复体坏了但没掉：制作，设计问题。<br>2.修复体脱落：粘接界面的损坏（一段时间后），与粘接相关。<br>第三阶段：牙体的粘接<br>第一章 牙体<br>1.牙釉质<br>A.牙釉质的组成：<br>釉柱（羟基磷灰石）<br>釉柱间质（蛋白有机物）<br>B.牙釉质成分比例<br>95%无机物，4%水，1%有机物<br>C.牙釉质的粘接模式——纯机械粘接？<br>釉质酸蚀后也要涂底漆，有一定化学粘接作用。<br>2.牙本质<br>A.牙本质组成<br>牙本质小管，有管周牙本质和管间牙本质，构成牙本质主体的是管间牙本质，有矿物质和大量胶原纤维。酸蚀后，矿物质失去，大量胶原纤维暴露，利于粘接。因此牙本质粘接的主力是管间牙本质的胶原纤维，而不是牙本质小管。冠周牙本质是大量矿物质和极少量胶原纤维。酸蚀后，管周牙本质脱矿，牙本质小管变粗。越靠近CEJ，小管数量少，管间牙本质多，越靠近髓腔，则相反。因此牙本质浅层的粘接力强。越接近牙髓的牙本质粘接力越弱，易敏感，粘接力不足。<br>B.牙本质成分构成比例<br>无机物：70%，有机物：18%，水：12%。牙本质是湿性的水合组成。<br>C.玷污层（羟基磷灰石碎屑和变性的胶原及细菌）<br>在水汽预备后，会形成玷污层，由层和栓构成。<br>D.牙本质的粘结模式：全酸蚀<br>1)玷污层被去除：35%-40%磷酸处理不超过15s。<br>2)冠周牙本质脱矿<br>胶原纤维暴露，管间牙本质脱矿，小管变粗。<br>有术后敏感的问题。<br>E.牙本质的粘接模式——自酸蚀<br>1)使用有机弱酸的混合物处理牙本质。首先接触玷污层，渗入后将玷污层改性。<br>2)冠周牙本质未见明显脱矿，管壁矿物质可与酸性单体产生化学结合。<br>第二章 粘接系统<br>第一节 粘接系统的组成与分类<br>1.粘接系统的组成<br>a.酸(Etch) 酸性<br>b.底漆(Primers) 酸性亲水性<br>c.粘接树脂(Bonding Resin) 疏水性<br>所有粘接系统的组成类似。<br>2.粘接系统的分类模式<br>a.年代及产品系列分类<br>第四代          All-Bond3           1990           3步<br>第五代          Single Bond        1995           2步<br>第六代          SE-Bond             2000           2步<br>第七代          iBond                  2002           1步<br>第八代          SBU                    2012           1步<br>b.酸蚀模式<br>全酸蚀——釉质和本质<br>自酸蚀——仅对牙本质<br>全酸蚀使用35%-40%磷酸处理牙釉质与牙本质，釉质发生脱矿，产生微孔，釉质表面自由能增加。（不酸蚀直接用粘接剂，很难渗入，酸蚀后产生微孔，粘接剂易渗入）牙本质玷污层消失，管间牙本质脱矿，胶原纤维暴露；冠周牙本质脱矿，牙本质小管变粗。因为酸的浓度高，需要冲洗。牙釉质干燥，牙本质需保持湿润，防止胶原纤维网塌陷。<br>自酸蚀：只针对牙本质，使用有机弱酸和底漆的混合液，或有机弱酸与底漆，粘接剂的混合液，去处理牙本质。玷污层未消失，只是改性。管间牙本质发生微脱矿，冠周牙本质未发生实际变化，但能产生实际结合。酸浓度较低且为混合物，不需要冲洗。</p>
<p><strong>个人总结：粘接是用一个界面将不同的组分连接到一起。形成粘接的主要有机械嵌合力，分子间作用力和形成化学键。牙科粘接目标主要是形成疏水界面。牙釉质主要为无机物，粘接力主要是机械嵌合力，也有部分化学粘接力。粘接力强大有效。牙本质含有机物较多，含有管间牙本质和冠周牙本质，牙本质粘接主要依靠冠周牙本质。冠周牙本质含有矿物质和大量胶原纤维，酸蚀后矿物质脱矿，大量胶原纤维网暴露，粘接剂与其结合后形成粘接力。牙本质粘接模式有全酸蚀和自酸蚀。主要区别是使用酸的浓度以及对玷污层的处理，全酸蚀浓度较高，完全去除玷污层，需要冲洗，并保持牙本质湿润。自酸蚀使用弱酸，使玷污层改性，部分酸蚀冠周牙本质。不需要冲洗。(冠周牙本质和管间牙本质在牙本质粘接中的作用，这个以前是没注意的。)</strong></p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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